The Role of Transfusion Oncology in the Care of Cancer Patients
August 16, 2021August 15, 2021
Yale Cancer Center
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- 00:00Funding for Yale Cancer Answers
- 00:02is provided by Smilow Cancer
- 00:04Hospital and AstraZeneca.
- 00:08Welcome to Yale Cancer
- 00:09Answers with your host
- 00:11Doctor Anees Chagpar.
- 00:13Yale Cancer Answers features the latest
- 00:14information on cancer care by
- 00:16welcoming oncologists and specialists
- 00:18who are on the forefront of the
- 00:20battle to fight cancer. This week
- 00:22it's a conversation about transfusion
- 00:24oncology with Doctor Edward Snyder.
- 00:26Doctor Snyder is a professor of
- 00:28laboratory medicine at the Yale School
- 00:30of Medicine where Doctor Chagpar is
- 00:33a professor of surgical oncology.
- 00:36Maybe we can start off by
- 00:38you telling us a little bit
- 00:41about yourself and what it is you do.
- 00:44I'm a professor of laboratory medicine.
- 00:46I've been in the field
- 00:48for almost four decades,
- 00:50and transfusion medicine is basically
- 00:53what I do, all aspects of it,
- 00:55supplying the blood,
- 00:57seeing people who have any reactions
- 00:59and providing consultation to
- 01:00oncologists whose patients
- 01:01may need a blood transfusion.
- 01:04And they have some difficulties.
- 01:07Talk a bit more about that whole specialty.
- 01:09Because for many of us
- 01:11we don't really think about
- 01:13transfusion medicine or transfusion
- 01:15oncology as a specialty in and of itself.
- 01:21Tell us a bit more about
- 01:24what's the purview of
- 01:26people who specialize in that area?
- 01:27Transfusion medicine is an area
- 01:31that originally started off in
- 01:35pathology and what happened was as
- 01:38the field grew pretty much stimulated
- 01:40by infectious disease concerns,
- 01:42it became much more of a consultive
- 01:45service involving medicine and surgery,
- 01:47so the term blood banking,
- 01:49which was really more of the storing
- 01:51of blood and so forth which we
- 01:54can talk about in a little bit,
- 01:57but the consultative aspect of the service
- 02:00where we talked to other physicians,
- 02:02you had trouble providing blood
- 02:04products for patients because of
- 02:07a variety of concerns and people from
- 02:09a variety of specialties, pathology,
- 02:12my backgrounds in internal medicine
- 02:14and hematology,
- 02:15others are in anesthesiology or surgery.
- 02:20And it is more than just storing blood in a refrigerator.
- 02:23It really has to do with supplying the
- 02:27appropriate blood component for a patient
- 02:29in the right amount and at the right time.
- 02:33And most physicians, the terminology
- 02:37I use or phrase I use,
- 02:38if you don't know your jewels,
- 02:41know your jeweler, and most physicians don't
- 02:43really know much about blood transfusion,
- 02:45so they rely very heavily on the blood bank.
- 02:47Tell us a little
- 02:49bit more about the role of
- 02:51transfusion medicine in oncology.
- 02:53I mean, many of us think about using
- 02:55blood in trauma situations where
- 02:57people have lost a lot of blood.
- 03:00But for cancer patients,
- 03:01things might be a little bit different.
- 03:04What are the needs of cancer patients
- 03:06when it comes to transfusions?
- 03:09Many of the chemotherapeutic
- 03:12regimens that are used to treat
- 03:14cancer cause what's called a
- 03:17hyperproliferative state in the bone marrow.
- 03:19That is, the bone marrow is affected
- 03:22by the chemotherapy in ways that are
- 03:25similar to the effect it has on the tumor.
- 03:28And the goal of chemotherapy
- 03:30would be to specifically have a
- 03:33negative impact on the tumor and
- 03:35to leave all healthy tissue alone.
- 03:40The chemotherapy also lowers the bone
- 03:42marrow's ability to make new blood cells,
- 03:45red cells or platelets,
- 03:46and when that happens,
- 03:48the patient becomes anemic and then
- 03:50they need a blood transfusion or if
- 03:52their platelet count gets very low,
- 03:55they'll need a platelet transfusion.
- 03:56The concern is that when you start giving
- 03:59blood products to people that they can
- 04:02develop an antibody to the component,
- 04:04the same way when you get a vaccination,
- 04:07you develop an antibody to the material
- 04:10that's injected and some people develop
- 04:12antibodies to red blood cells.
- 04:14Inside they have hemoglobin,
- 04:16which carries oxygen,
- 04:18which is important.
- 04:19But the surface of the cell is also studded
- 04:22with a variety of chemicals called antigens,
- 04:25which are foreign to some patients.
- 04:27Not everyone has the same blood type.
- 04:30Everyone knows about ABO types,
- 04:31but there are hundreds of other
- 04:34blood types that are on the cell,
- 04:36most of which are not clinically significant,
- 04:39but some are.
- 04:40And when some of those blood
- 04:43types of the transfused blood,
- 04:45even though they're compatible for the
- 04:48ABO system and also the RH system which
- 04:51many people know of many of the other
- 04:54blood antigens with names that most
- 04:56people probably haven't heard of,
- 05:02they can develop antibodies to that,
- 05:04and when that happens,
- 05:06it becomes difficult to find
- 05:08blood for that patient,
- 05:09especially if they've had
- 05:11multiple transfusions.
- 05:12And they've developed multiple antibodies,
- 05:14so the blood bank director and that
- 05:16point the consults with the oncologist
- 05:18because the patient has gotten chemotherapy,
- 05:20their blood count is dropped and
- 05:22they need to get a transfusion most
- 05:25of the time it's not a problem
- 05:27if things go smoothly,
- 05:29but on occasion when there are
- 05:31problems they contact the blood bank
- 05:33and we work with the physician to
- 05:36determine how much blood is needed.
- 05:38Also,
- 05:38many surgical patients who have cancer
- 05:40require blood during operative procedures.
- 05:42And we work with the surgeons as
- 05:45well to see how much blood is needed
- 05:49and whether they need platelets.
- 05:51For example,
- 05:52platelets are little fragments
- 05:55of blood cells.
- 05:57Unrelated to red cells,
- 05:58although they all derived
- 06:00from common lineages,
- 06:01going way way back to embryonic cell growth.
- 06:06And platelets are also needed and
- 06:08for patients and the number of
- 06:10platelets may be lower because again,
- 06:12the chemotherapy or other illnesses
- 06:14that are part of the illness itself
- 06:17may cause the platelets to drop.
- 06:19So if you were to transfuse a platelet,
- 06:22the platelet count may not go
- 06:23up to the level
- 06:25that's wanted, and you wind up having
- 06:27a patient who can't really receive
- 06:29platelet transfusions and get
- 06:31the response that's needed.
- 06:33The platelet count is not
- 06:37elevated as expected and that definitely
- 06:39requires a consultation from the
- 06:41blood bank with the clinician to
- 06:43determine what other options there are,
- 06:45and there are multiple options
- 06:47for finding compatible platelets.
- 06:49Then there are other patients who
- 06:51have other illnesses where the plasma
- 06:54levels of some plasma products may be low,
- 06:57and they would need a plasma transfusion,
- 07:00so blood banks get involved in a
- 07:04variety of issues related to oncology,
- 07:06whether it's surgical or
- 07:09whether it's chemotherapy, or
- 07:11whether it's illness based.
- 07:13In some cancers,
- 07:14the bone marrow is affected by the growth
- 07:17of the tumor and the tumor actually
- 07:20replaces some of the bone marrow
- 07:22causing platelet counts to become too low
- 07:26and for patients who actually have a good
- 07:29lifestyle and we consult for those
- 07:31issues as well, so
- 07:34in addition,
- 07:34if someone gets a transfusion and
- 07:37they have a reaction of some type,
- 07:39whether it's a nallergic reaction or a fever,
- 07:42we consult with that as well.
- 07:44So we're pretty busy.
- 07:46It's a very clinically oriented specialty.
- 07:48You make a few really good points,
- 07:51and one of which is that some
- 07:53cancer patients will need repetitive
- 07:55transfusions and can build up
- 07:57these antibody responses.
- 07:59So just out of curiosity,
- 08:02how do you get around that?
- 08:05I think this is a question that
- 08:08many patients and their families
- 08:10may have is should we be donating
- 08:13our own blood and banking it,
- 08:15knowing that we may,
- 08:16with chemotherapy, for example,
- 08:18need a transfusion in the future?
- 08:21Are there particular banks that
- 08:24have rare blood types where
- 08:27people who have developed
- 08:29many antibodies to various
- 08:32antigens can still find blood?
- 08:35How do you work around those issues?
- 08:39Well, one needs to be creative,
- 08:41so let's get some definitions,
- 08:43orthologous blood auto logus who
- 08:44pronounced autologous is your own
- 08:46blood being given back to you,
- 08:48and so some of our listeners may say,
- 08:50well, why can't I store my own blood?
- 08:53Well, if your blood count is high enough,
- 08:56you can store your own blood
- 08:58someplace and it used to be very popular
- 09:00to do that during the AIDS
- 09:03epidemic when people were very concerned
- 09:05but that when the AIDS,
- 09:06a virus and how to treat, it became.
- 09:09Part of standard of care
- 09:11for for AIDS patients,
- 09:12the need to provide it their own
- 09:14blood really wasn't important anymore.
- 09:16And many blood centers stopped that practice.
- 09:19One of the problems with donating
- 09:21your own blood is you have to
- 09:23have a blood count high enough,
- 09:25otherwise you become anemic and you just
- 09:27have to give you the blood right back
- 09:30or they were actually blood banks that
- 09:32were set up where you could freeze blood,
- 09:35which was fine as I used to say,
- 09:37unless you're on a vacation in Hawaii.
- 09:40And something happens and you need
- 09:41blood and the blood is frozen in the
- 09:44New York or in Washington or New Haven.
- 09:45And you can't get to it.
- 09:49It became clear that donating
- 09:51blood for yourself really wasn't
- 09:53going to be very useful,
- 09:54and practice is not really
- 09:56done much anymore at all.
- 09:58Very some places don't even accept some blood
- 10:01centers don't even accept autologous blood.
- 10:03The second would be a directed donation
- 10:06where a family member would donate
- 10:09a unit of blood specifically for.
- 10:12The patient that requires,
- 10:13of course that the blood be compatible,
- 10:16which is often is not.
- 10:17In addition, come,
- 10:18it's not just a relative,
- 10:20but some people wanted close
- 10:22personal friends,
- 10:22or,
- 10:22as I used to comment,
- 10:24the captain of their bowling
- 10:26team was a close friend,
- 10:27so they wanted the captain of the
- 10:29bowling team to donate blood for
- 10:31them because they believe that
- 10:33because they were their friend,
- 10:35they were biologically safer as
- 10:36a donor and they didn't have to
- 10:39worry about different diseases.
- 10:40Well, quite frankly, you don't know what.
- 10:43The captain of your bowling team is,
- 10:45it does after they leave the bowling alley.
- 10:49So directed donations as a means
- 10:51of getting blood from someone
- 10:53you're comfortable with doesn't is
- 10:55in practice much anymore either.
- 10:58So that leaves us with the third category,
- 11:01which is what is called allogenic LLOGENEC,
- 11:04which is blood from other people.
- 11:06And that's what almost all the blood
- 11:09that we provide is blood from people
- 11:12who are concerned about their fellow.
- 11:15Human and they donate blood or they
- 11:18donate platelets or they donate red
- 11:21cells or plasma to blood centers.
- 11:23And that's the blood that's given.
- 11:25We have ways of matching the blood
- 11:27so that the antigens I talked
- 11:29about are not a problem.
- 11:30We pick out for someone who was typo.
- 11:33We give old blood.
- 11:34If someone is type A,
- 11:35we can give type A blood or
- 11:37type O blood and so forth and
- 11:39so on for the various antigens.
- 11:41And we have a whole system
- 11:43set up in blood banking of.
- 11:45Of cells that allow us to determine
- 11:48blood that's compatible and we do
- 11:50that so that kind of compatibility
- 11:52testing is sort of the bread and
- 11:54butter of what blood banks do and
- 11:56and that's that is taken care of if
- 11:59it comes to problems where someone
- 12:01with a local blood bank can't
- 12:03find anything that's compatible.
- 12:05You have systems like the Red Cross
- 12:07that have 35 or 40 blood centers
- 12:09around the country and they have
- 12:11what they call rare donor files
- 12:13where they have peoples blood types
- 12:15on record and they can ask for
- 12:18blood to be sent if they have them
- 12:21frozen or they may have liquid
- 12:24units that aren't frozen.
- 12:26And there are ways of working
- 12:28with the larger blood providers
- 12:30to work around that issue.
- 12:32There are other blood systems
- 12:34besides the ABO system.
- 12:36One is the HLA system and
- 12:38people may have antibodies to HLA or
- 12:41they may have antibodies to platelets.
- 12:44There are platelet antigens like there
- 12:46are red cells and again the Red
- 12:49Cross has donor records and we
- 12:51can test and find people who are
- 12:54compatible for the patient.
- 12:56There's a whole series of
- 12:58things that we have to do.
- 13:00You can't just have a small blood
- 13:02bank working on its own.
- 13:05You really need to be part of a large system,
- 13:08certainly a hospital like Yale,
- 13:10with 1600 beds and many,
- 13:12many patients who are fortunately
- 13:14living longer and longer with malignant
- 13:16conditions that are treatable.
- 13:18But when they're transfused a lot during
- 13:20their therapy when they come back,
- 13:22if they have a relapse then the
- 13:25possibility of having incompatible blood
- 13:27either for red cells or incompatibility
- 13:30with platelets becomes a real issue
- 13:32and you need a large support structure
- 13:35in blood centers to provide blood
- 13:37so that the patient can be treated
- 13:39and go into remission again.
- 13:41So there's a lot we have to do.
- 13:44We consult on a lot of different
- 13:47issues and it keeps us pretty busy.
- 13:50Great, well, we're going to take a
- 13:53short break for a medical minute.
- 13:56Please stay tuned to learn more
- 13:58about transfusion oncology
- 13:59with my guest doctor Edward Snyder.
- 14:02Funding for Yale Cancer Answers
- 14:04comes from Smilow Cancer Hospital where
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- 14:08oncologists committed to providing
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- 14:13Find a Smilow Care Center near
- 14:16you at yalecancercenter.org.
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- 14:27with over 1000 patients in Connecticut alone.
- 14:30While Melanoma accounts for only
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- 15:08More information is available at
- 15:10yalecancercenter.org. You're listening
- 15:12to Connecticut Public Radio.
- 15:16Welcome back to Yale Cancer Answers.
- 15:18This is doctor Anees Chagpar and I'm
- 15:21joined tonight by my guest Doctor Ed Snyder.
- 15:24We're talking about transfusion
- 15:25oncology and right before the break
- 15:27Ed you were talking about the fact
- 15:30that some cancer patients require
- 15:32multiple transfusions and there's
- 15:34really a benefit to being part of a
- 15:37large system such as the Red Cross,
- 15:39where if you have developed
- 15:41antibodies to a particular antigen in blood,
- 15:44that there still are rare donors who
- 15:47could provide blood for you,
- 15:49but I wonder about other modalities
- 15:52that might actually reduce our
- 15:54need for blood transfusions.
- 15:56So what are your thoughts
- 15:58on things like that?
- 16:00I know that for many of our
- 16:03cancer patients there are drugs,
- 16:05for example,
- 16:06that oncologists use either to increase
- 16:09red blood cells or white blood cells.
- 16:13How effective are they and do
- 16:15you find that that reduces the
- 16:17transfusion needs for patients?
- 16:20Well, yes, the saying that we have
- 16:23in transfusion is the safest unit
- 16:25of blood is the one you don't get.
- 16:28And even though we do everything
- 16:30we can to ensure the blood safety,
- 16:33there are still the possibility of concerns
- 16:36regarding fever or transmission of illnesses.
- 16:38As anytime you do any kind of a
- 16:41transplant which really a transplant
- 16:43is really what a blood transfusion is.
- 16:47Only it's a transplant of red blood cells.
- 16:50Platelets.
- 16:50There are a variety of reagents which
- 16:53are designed to stimulate red cell
- 16:56production from some of those have
- 16:58shown to cause problems and are
- 17:00not used as often as they were.
- 17:07There are agents that can be used
- 17:10to stimulate platelets as well.
- 17:18But those are predicated on the fact
- 17:20that your bone marrow can actually make
- 17:23more if your bone marrow is damaged
- 17:26and you don't have the cells that
- 17:28can respond to those chemicals and
- 17:30actually make more of those kinds of
- 17:33cells that they're not going to be effective.
- 17:36Although there are those chemical
- 17:38reagents that can be used,
- 17:40they may in some patients have
- 17:42limited usefulness, so a transfusion
- 17:44I think although people try
- 17:46to minimize the times,
- 17:48blood transfusions are needed,
- 17:50they still need to be there.
- 17:53One of the things that's important
- 17:54about that is a concern about the reactions.
- 17:58And there's a variety of types of reactions,
- 18:01one of which is a febrile which is a fever,
- 18:04and that's because when you're
- 18:06giving a foreign protein,
- 18:07which blood cells have proteins on them,
- 18:09you can get a fever.
- 18:11There's that in and of
- 18:13itself is not dangerous.
- 18:14It's uncomfortable,
- 18:14and we like to minimize that from happening.
- 18:17But patients do can get a fever.
- 18:20They can also get hives,
- 18:21or they can get allergic
- 18:23reactions they can also have some
- 18:25other kinds of complications,
- 18:27all of which the transfusion
- 18:29service is aware of and we try
- 18:32to minimize as much as possible.
- 18:34One of the areas that's
- 18:36a really big concern is,
- 18:38as I mentioned earlier,
- 18:40infectious problems and that
- 18:42has led to the production of a whole
- 18:44new field of transfusion medicine,
- 18:47which is pathogen reduction.
- 18:5110-15 years ago
- 18:52if there was a virus that came out
- 18:56like Zika or West Nile,
- 18:58we knew there was a virus
- 19:01that had entered the blood supply,
- 19:04molecular biology was used to
- 19:07identify the virus,
- 19:08determine where it could be neutralized, and
- 19:10tests were made to identify it,
- 19:13treatments were developed.
- 19:14But then all of that cost money,
- 19:17and then the hospitals and the blood
- 19:20centers had to spend a lot of money.
- 19:23For that,
- 19:24the FDA took a long time to approve
- 19:26the testing and evaluation of
- 19:28donors for that particular illness.
- 19:30And while all this was going on,
- 19:32Medicare may or may not
- 19:34have reimbursed for it.
- 19:35So there was a financial what I call
- 19:37the banking part of blood banking,
- 19:39and then every time you got through
- 19:41with one virus, another one came along.
- 19:44So the field decided to move to a new type
- 19:47of tech that is called a reactive approach.
- 19:49That is, you identify a pathogen
- 19:51of some sort or something that
- 19:53shouldn't be in blood,
- 19:55whether it's a virus or bacteria,
- 19:58and then you try to mitigate
- 20:01it or get rid of it.
- 20:04This pathogen reduction technology
- 20:06is not reactive, it's proactive.
- 20:08There are reagents that are put into
- 20:10the blood bag that are designed to
- 20:13inactivate pathogens by attacking
- 20:15the DNA and RNA of those pathogens,
- 20:17blood cells,
- 20:18the human red cells and platelets
- 20:21do not have DNA or RNA because
- 20:24it's not part of what that
- 20:25particular cell has,
- 20:26they had them when they were growing,
- 20:28but when they become mature cells,
- 20:30the DNA and RNA isn't there.
- 20:32So the only thing that has DNA or
- 20:34RNA in a unit of blood is a pathogen.
- 20:36So if you can put chemicals in
- 20:38that affect the DNA or RNA,
- 20:40you're really sparing the good
- 20:42cells and you're just trying to
- 20:43get rid of any pathogen.
- 20:45Well, you can say with all the testing
- 20:47why should there be a pathogen there?
- 20:49There shouldn't be,
- 20:49but sometimes pathogens are in
- 20:51very low levels like bacteria,
- 20:52but then they can grow.
- 20:54Other times,
- 20:55new viruses come in like the COVID-19
- 20:58virus is not transmitted by blood,
- 21:01fortunately,
- 21:01as bad as it is,
- 21:04and it's a horrific virus,
- 21:06but it is not transmissible by blood.
- 21:08The HIV virus or AIDS with
- 21:11the pathogen reduction technology
- 21:13it puts reagents in the blood
- 21:15bag that will inactivate pathogens
- 21:18and many pathogens share common
- 21:20DNA or RNA types so that the
- 21:23reagents that are put in
- 21:25will be effective against them.
- 21:27And indeed the pathogen reduction
- 21:29technology that has been studied
- 21:32and proven to be successful
- 21:33it doesn't
- 21:36activate the COVID-19 virus,
- 21:38although it's not a bloodborne problem,
- 21:40but the next one might be,
- 21:42so pathogen reduction has been approved
- 21:45for platelets and for plasma they are
- 21:48currently doing clinical trials for
- 21:50red cells and we are doing several
- 21:53of those trials at Yale and at
- 21:5515 other sites around the country
- 21:58and once we have pathogen
- 22:00reduction approved then we will have
- 22:03a much safer blood supply because
- 22:05not only will we be testing for known
- 22:07viruses and pathogens and bacteria,
- 22:09but also for unknown ones,
- 22:11which is critical for the safety
- 22:13of the blood supply.
- 22:15These kinds of technologies,
- 22:16molecular diagnostics and so forth
- 22:18are really the future of transfusion.
- 22:20In addition,
- 22:21there are other types of approaches,
- 22:23immunotherapy to treat patients
- 22:25instead of using
- 22:26chemotherapy that I mentioned earlier,
- 22:27which can have cytotoxic,
- 22:29which means it's toxic to cells
- 22:31which can lower the amount
- 22:33of bone marrow that
- 22:34you have. Other types of therapy CAR
- 22:37T cell therapy you may have heard
- 22:39of or other types of immunotherapy
- 22:41where you do not depress the bone
- 22:44marrow when those patients may not
- 22:46need transfusions because their blood
- 22:47counts don't get that become that low.
- 22:50There are other aspects of transfusion
- 22:52medicine that those patients
- 22:54require and we don't have time in this
- 22:57discussion to go into all of that,
- 22:59but you can be sure that the blood
- 23:02transfusion service at the Hospital
- 23:04is working closely with the oncologists
- 23:06and the surgeons to ensure that the
- 23:09best and the safest possible blood for
- 23:11their patients and our field grows
- 23:13as the field of therapeutics grows.
- 23:16So we have the patient's best
- 23:18interest at heart.
- 23:19There are many sort of tricks in our bag
- 23:22if you will, of how we can provide
- 23:25safe blood pathogen reduction.
- 23:27Again, is a critical advance in the field
- 23:30and we just have one more cell type.
- 23:32The red cells that the research
- 23:35is being done on
- 23:36now to have that available in
- 23:39a couple of years.
- 23:41And the goal,
- 23:42of course,
- 23:43is to be able to treat patients
- 23:45and eventually just do away
- 23:47with this field of transfusion,
- 23:49because you won't need to give blood.
- 23:52But that's not in the foreseeable future,
- 23:54so the best we can do is provide
- 23:57the safest possible blood,
- 23:59the least amount needed,
- 24:00and the best quality for
- 24:02our patients.
- 24:03And you mentioned
- 24:05the term pathogen reduction
- 24:07it's not pathogen elimination,
- 24:09but it still is
- 24:11really low odds that people get
- 24:14infections with blood these days.
- 24:16Can you remind us about those numbers?
- 24:19What is the risk of
- 24:21getting HIV or hepatitis from a
- 24:24bag of blood these days?
- 24:26The risk of HIV is in the millions,
- 24:30one in a million, one in many millions.
- 24:33That's for HIV.
- 24:34It's also true for other types of viruses.
- 24:38Hepatitis is somewhere in the range
- 24:41of about one in 250,000 to 100.
- 24:44I'm sorry 1 to 250,000
- 24:46to 1 to 500,000 for bacteria.
- 24:49The numbers are higher because bacteria
- 24:52are much different organisms than viruses
- 24:55so the risk of getting a septic
- 24:57transfusion reaction is extremely low,
- 25:00but the risk of getting some bacteria
- 25:03growing in blood is somewhere in
- 25:05the range of 1 to the 30,000 in
- 25:08that range which are several orders
- 25:11of magnitude less than the HIV.
- 25:14Part of that problem is you can't
- 25:16test for all the different kinds
- 25:19of bacteria that there are.
- 25:21Some of them grow slowly.
- 25:22It depends on where the bacteria came from.
- 25:25There shouldn't be any bacteria in blood,
- 25:27and most of the time they're not.
- 25:30But that's where the pathogen
- 25:32reduction comes in,
- 25:33because pathogen reduction would
- 25:34inactivate any viruses or any bacteria
- 25:36that get through the testing that we have.
- 25:39So it's not something
- 25:41to be concerned about.
- 25:43Because the donor
- 25:45history is extremely inquisitive.
- 25:47We're asking a lot of questions,
- 25:50many of which took years
- 25:53to get accepted because
- 25:55a lot of the questions relate to
- 25:58sexual practices and many people were
- 26:01offended by those questions when we
- 26:03started asking it when we realized
- 26:05that HIV was sexually transmitted.
- 26:07But it was required to do it
- 26:09for the safety of the patients
- 26:12who are receiving the blood.
- 26:14But now that we know more about
- 26:16how to treat these diseases,
- 26:19many of those individuals come
- 26:21who are negative for these various
- 26:23tests are able to donate blood
- 26:26and it's a different field.
- 26:28We have to grow with the field as the
- 26:31knowledge grows and
- 26:33that's what transfusion is,
- 26:35there's a practical side
- 26:36for the patient care.
- 26:38There's the collection side and
- 26:40there's also the research side
- 26:42which is allowing us to advance
- 26:44the field in so many different ways.
- 26:47One last question is,
- 26:49perhaps,
- 26:51we had mentioned the fact that
- 26:54as therapeutics advance
- 26:55we may have less and less need for
- 26:59transfusion, but at the moment it
- 27:01still is a part of clinical care.
- 27:05How do you get around the needs of patients
- 27:09who cannot take due to religious reasons
- 27:12for example, blood?
- 27:14Are there other options for
- 27:16them outside of a transfusion?
- 27:18That's an excellent
- 27:20question. There are individuals who
- 27:22do not want a blood transfusion.
- 27:25For a variety of religious reasons or
- 27:27other reasons, for those individuals,
- 27:29consultation with the patients physician
- 27:31is required, as well as the family.
- 27:34We have a family meeting to discuss options
- 27:37and if blood transfusion is not one of them
- 27:40you mentioned the various reagents that
- 27:43are developed to stimulate the production
- 27:45of platelets or red cells in the person.
- 27:48Those chemicals can be given that
- 27:50may be possible to take some blood
- 27:53from the patient prior to treatment
- 27:55and store it so that if the
- 27:58patient's count does drop,
- 27:59they will have stored their own
- 28:01blood in advance, which in someone
- 28:03who doesn't want to get transfusion,
- 28:05of someone else's blood,
- 28:07may be willing to accept their own blood.
- 28:10Some individuals don't want to
- 28:11accept blood from themselves,
- 28:13that's been taken out of their body,
- 28:15separated, stored, and then given back.
- 28:17So it depends on the degree to which the
- 28:20individual will be willing to accept blood,
- 28:22but those can cause some very
- 28:25difficult treatment situations.
- 28:26That has to be discussed with the patient,
- 28:29the patient's family,
- 28:30the physician and the blood bank.
- 28:32Doctor Edward Snyder is a
- 28:34professor of laboratory medicine
- 28:36at the Yale School of Medicine.
- 28:38If you have questions,
- 28:39the address is canceranswers@yale.edu
- 28:41and past editions of the program
- 28:43are available in audio and written
- 28:45form at yalecancercenter.org.
- 28:47We hope you'll join us next week to
- 28:49learn more about the fight against
- 28:51cancer here on Connecticut Public
- 28:53radio funding for Yale Cancer answers.
- 28:56Was provided by Smilow Cancer
- 28:58Hospital and AstraZeneca.